Hi! I'm new here and hoping someone can give me peace of mind. I am almost finished with my 6 months of supervised diet and exercise. My last weigh in is actually in November. I meet the 40 BMI criteria with a 41 and have one co-morbidity although not required unless I am below 40. However, I have spoken to UHC 4 times in the past week and am so confused about when I can actually have surgery. After I receive authorization, which will hopefully be in December, I was told by one rep that I have to wait 6 months from approval date to have surgery. When I called back, the next rep said she'd check with the clinical reps, which she did, and they told her they didn't have any stipulations on their side that required an additional 6 month waiting period. It's not even for dieting/exercise purposes. Just simply waiting. And then tonight- another rep said I do have to wait, per a different clinical rep he spoke with. Has anyone experienced or even heard of this waiting period? I would think all tests/evaluations/data would be out dated after 6 months.

Anyone know if you can fluctuate during the six months? As long as your less than what U were when u started??

I was told I could lose just not so much to go below the 40BMI. But I absolutely could not gain.

I also have uhc. I was told I us to be on a 6 month supervised diet. I did lose each month 30 lbs total. But I loose and gain that last 10 lbs of that 30 lbs and the doctor did not say anything. I guess it is up to your doctor and insurance plan.

My weight loss was required by the surgeon I had to go to that clinic and they made me meet with a nutritionist and exercise person take a history weigh you put you on a diet mine was south beach requirement to lose 5% before you can even meet the surgeon he won't do any surgeries if you do not comply with his terms then when you have done this they schedule the pre op testing and when that was all done u schedule for surgery I started this in June 2014 and due to all the requirements and testing it took weeks to get any appts for any testing and weight loss required first it took me until dec22 to get surgeon approval then he went on vacation for two freaking months I didn't have surgery until almost end of February and he told me if you gain a lb no surgery

Edited October 21, 201510 yr by shellyd88

@@shellyd88 I'm glad I have pestered the heck out of my insurance company. I spoke with the insurance coordinator for the surgeon's office last week and discussed my concern. She had called the day before to verify my benefits and was completely unaware of the additional 6 month waiting period when I mentioned it to her. Stated that she was not aware of nor did she believe that was the case.

When I called and spoke with the care coordinator team from UHC today, they stated that I MUST schedule surgery 6 months out from my precert and if I were to have surgery before that 6 month period, there's a huge chance that the claim would be denied and I'd either be stuck footing a $50k+ bill or the office would have to write my claim off.

I plan to call the office tomorrow to run this back by them and make sure they note it everywhere in my chart so that it cannot be missed, no matter who I work with when scheduling is done. I would rather wait 6 more months than be in debt up to my eye balls from medical bills. If that were the case, I'd just assume go have the surgery and not even worry about jumping through the insurance hoops.

I have found that the dr or clinic/ program likes to verify your insurance coverage and approval before they begin your mandatory weight loss nutrition appts and all testing begins a lot of insurance make you have some period of time to have weight loss usually required by the surgeon not the insurance but the insurance goes along with this as there is a chance u will quit or get tired of all the bs and change your mind I've also found that they will never give a straight answer

Edited October 28, 201510 yr by sassyfrass23

Good stay on top of everything I found I sure had to I also kept copy's of all test results etc anything they asked for I had a copy in a file for myself as I seemed to be getting the run around constantly they didn't receive this or that or never got faxes etc etc I even brought this file with me to day if surgery just in case and I'm glad I did I had to take these shots for I think a week before surgery they said I took the wrong dose etc and wanted to cancel my surgery I had my copy's of RX and a receipt from pharmacy to prove that was not right I was later told someone recorded the info wrong in my file